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General NPI Number Information
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NPI Number | 1700887155
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Entity Type | Organization
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Legal Business Name | TEXAS MIDWEST SURGERY CENTER, LLC
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 06/23/2014
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Provider Practice Location Address
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Address Line | 751 N 18TH ST
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City | ABILENE
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State | TX
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Zip | 79601-3017
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Country | US
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Telephone | 325-677-6555
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Fax | 325-677-6976
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Provider Business Mailing Address
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Address Line | 751 N 18TH ST
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City | ABILENE
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State | TX
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Zip | 79601-3017
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Country | US
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Telephone | 325-677-6555
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Fax | 325-677-6976
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Authorized Official
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Title or Position | BOARD MEMBER
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Name | DR. SHANNON E COOKE
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Credential | M.D.
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Telephone | 325-672-4372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 007182
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License Number State | TX
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